This project involved the analysis of linked birth and death certificates from Missouri for the years 1980-1984. The 200,000 births occurring during this period are being studied to determine whether or not Cesarean sections performed for very low birth weight infants have any advantages over vaginal delivery after adjusting for various complications of delivery. Our preliminary analysis suggests that the vaginal delivery of a very low birth weight infant carries a greater risk of day 1 death than does Cesarean section. However, the advantage is lost during the first week of life when those infants delivered by Cesarean section have a higher death role than those delivered vaginally. We suspect that the lower first day death rate for infants delivered by Cesarean section is related to the greater attention and resuscitative efforts these infants receive. The study has been accepted for publication by the Journal of the American Medical Association.